68900251 - OPS HUMAN SERVICES PROGRAM SPECIALIST

Requisition No: 878405 

Agency: Agency for Health Care Administration

Working Title: 68900251 - OPS HUMAN SERVICES PROGRAM SPECIALIST

 Pay Plan: Temp

Position Number: 68900251 

Salary:  $17.00 Hourly 

Posting Closing Date: 07/07/2026 

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This is a full-time Other Personal Services (OPS) position, with regularly scheduled hours of Monday-Friday 8:00 a.m. to 5:00 p.m.

This Human Services Program Specialist (HSPS) position will be filled at a non-negotiable rate of $17.00 per hour.

This position does not involve travel-related activities.

Successful completion of a criminal background investigation is a condition of employment. 

A good attendance record is essential for any individual in this position as the work involved occurs daily and is time sensitive.

The individual in this position is expected to report to work daily and on time.

The Florida Medicaid program is one of the five largest in the country and has an estimated $38 billion annual budget.

Each month Florida Medicaid covers medical services for almost 4 million recipients.

To most effectively serve this large patient population, one of the Agency goals is to ensure fewer budgeted dollars are lost to fraud, abuse, and waste.

The Office of Medicaid Program Integrity (MPI) does this specifically through audits and investigations of healthcare providers, including managed care plans, suspected of engaging in fraudulent or abusive behavior, as well as overpayment recoveries, administrative sanctions, and the referral of suspected fraud or other criminal violations for law enforcement investigation.

MPI is organized by the functions that fall within the Bureau’s responsibility:  Operations, Data Detection, Investigations, Overpayment Recovery, and Managed Care oversight. 

MPI operates with dynamic and fast-paced units that work closely with one another to serve the overall bureau mission. 

To address the complexity and scope of fraudulent and abusive behavior in the Florida Medicaid program, these units are responsible for developing novel methods and technologies to fight fraud, abuse, and waste.

To do this, these highly collaborative and innovative units rely on teams with diverse educational and experience backgrounds.

The candidate selected for this HSPS position will report to the Detection Intake Unit within Medicaid Program Integrity (MPI).

This selected candidate is responsible for returning calls to individuals seeking assistance with submitting complaints related to Medicaid provider fraud and abuse.

The candidate will support Intake Unit analysts by assisting in generating referrals to other bureaus within the Agency for Healthcare Administration, other state agencies, law enforcement, and/or federal agencies.

The position also involves monitoring incoming complaints, contacting individuals for additional information regarding online complaint submissions, and collaborating with team members on assigned projects.

The selected candidate is expected to maintain current knowledge of the investigating methodologies and procedures employed by MPI as well as common fraud schemes, patterns, and trends regarding regional and state-specific concerns in health care fraud and abuse.

The selected candidate must also maintain current knowledge of the Florida Medicaid program including rules and regulations within the Agency for Healthcare Administration, pertinent contract provisions, statutes and laws, program manuals, provider handbooks, and Medicaid claims processing procedures.

This unit is seeking a candidate with experience specifically related to customer service, proficiency in computer applications, clear and effective writing, and the ability to prepare accurate, well-organized documents.

The candidate should be adaptable, able to work closely with team members, and adjust to shifting priorities and projects. Included in the functions of this HSPS position are activities such as:

•Assisting callers with submission of complaints and gathering additional information for complaints received.

•Receiving mail and additional complaint documents to forward to appropriate staff members in a timely manner. 

•Composing and sending referrals to outside entities as necessitated.

•Assisting the Intake Manager with monitoring of the complaint inbox.

•Collaborating with team members on projects and assignments.

•This position serves a large population of Spanish/Creole speaking customers and employees may be required to perform interpreter duties, if bi-lingual.

Benefits of Working for the State of Florida:

Working for the State of Florida is more than a paycheck. The State’s total compensation package for Other Personal Services (OPS) employees features a highly competitive set of employee benefits including:

•              No state income tax for residents of Florida;

•              State Group Insurance coverage options (must meet eligibility requirements), including health, life, dental, vision, and other supplemental insurance options;

•              Savings & Spending Accounts;

•              401 (a) FICA Alternative Plan administered through VALIC (tax deferred Retirement Savings Plan);

•              Participation in the Florida Deferred Compensation Plan (457b)

For a more complete list of benefits and eligibility requirements, visit www.mybenefits.myflorida.com.

What is OPS employment?

OPS employment is a temporary employer/employee relationship used for accomplishing short term or intermittent tasks.  OPS employees are at-will employees and are subject to actions such as pay changes, changes to work assignment, and terminations at the pleasure of the agency head or designee.

OPS employees do not serve probationary periods or become permanent in their positions because they serve at the pleasure of the agency head.

KNOWLEDGE, SKILLS, AND ABILITIES

Ability to solve problems and make decisions based on available information

Ability to execute projects and assignments timely and accurately within a fast-paced environment

Ability to work independently.

Ability to communicate effectively verbally and in writing

Ability to review and comprehend applicable federal and state laws, rules, policies, and regulations related to health care and enforcement activities.

Ability to demonstrate proficiency using Microsoft features including, Word, Excel, Outlook, and Internet Explorer.

Knowledge of research or investigative principles, practices, and techniques.

Possess investigative skills, research skills, written and oral communication skills, and organizational skills.

MINIMUM QUALIFICATIONS REQUIREMENTS

Two years of customer service experience.

Preference will be given to candidates that have a high school diploma or its equivalent.

LICENSURE, CERTIFICATION, OR REGISTRATION REQUIREMENTS

N/A

CONTACT: HELEN GUNN 850-412-4626

BACKGROUND SCREENING

It is the policy of the Florida Agency for Health Care Administration that any applicant being considered for employment must successfully complete a State and National criminal history check as a condition of employment before beginning employment, and, if applicable, also be screened in accordance with the requirements of Chapter 435, F.S., and Chapter 408, F.S.  No applicant may begin employment until the background screening results are received, reviewed for any disqualifying offenses, and approved by the Agency.  Background screening shall include, but not be limited to, fingerprinting for State and Federal criminal records checks through the Florida Department of Law Enforcement (FDLE) and Federal Bureau of Investigation (FBI) and may include local criminal history checks through local law enforcement agencies.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.